Application for Bonafide Certificate / Migration Certificate / Transcript
1. Name: Address
For Office Use Only Eligibility Verified (Yes/No)
Signature
PIN *Ph. (R): *Mobile: *Email ID: 2. Roll Number: 3. Course Code: 4. Centre Code: 5. Center Name: 6. Request for the issue of (put tick mark in one or more boxes) i) Bonafide Certificate ii) Migration Certificate iii) Transcript No. of Copies 7. * Briefly indicate the reasons for obtaining the above certificate:
8.
Academic Details (enclose XEROX copy of the Mark Cards of all Semesters) Mon & Year of Semester Semester Center Code Semester Total Passing Grade
9. Fee Paid Details (Refer to the Important Instructions) DD No: Date: Bank Name:
Remarks
Amount In Rs. Payable at Udupi/ Manipal only.
Certified that I have passed in all the semesters and the information given above is correct> I have not joined any other course of SMU. Place: Date:
Signature of the Applicant
1) XEROX copies of all Mark Cards
11. Address to which the Certificate to be dispatched (CAPITAL LETTERS) Name
2) X Standard Mark Sheet
Address
10. Checklist (put tick mark in appropriate box)
3) XII Standard Mark Sheet / Certificate 4) Degree Certificate / Provisional Certificate 5) Demand Draft * information is mandatory
PIN: Res/Mobile:
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IMPORTANT INSTRUCTIONS Read the following instructions carefully before filling up the application form. (1) S.No.1: Please write Name and Address, Phone Numbers and email ID details. (2) S.No.2: Write your Reg/Roll Number. (3) S.No.3: Write the Course Code of the course you have completed. (4) S.No.4: Write the Learning Center Code. (5) S.No.5: Write the Learning Center Name. (6) S.No.6: Write the number of additional copies of transcript required. (7) S.No.7: Briefly indicate the purpose for which you require Bonafide and/or Migration Certificate and/or Transcript (compulsory). (8) S.No.8: Please fill in the academic details in the table. •
In the column “Centre Code” indicate the learning centre code through which you have appeared for the respective Semester Examinations.
(9)S.No.9: Fill in the DD details. DD must be drawn in favour of ‘Sikkim Manipal University, DE’ payable at Manipal/Udupi, only. (10)S No.10: Checklist: Put the ‘tick’ mark in boxes as per enclosures list. (11)S.No.11: Write the complete Address to which the Bonafide Certificate / Migration Certificate / Transcript is to be dispatched in CAPITAL LETTERS only. Certificates will be dispatched only to student’s residential address. (12) Enclose the following documents along with the application form: a)
XEROX copy of the Consolidated Marks Card (CMC) and Degree Certificate (DC). In case, if the student has not received the Consolidated Marks Card and Degree Certificate, enclose the following: (I) Duly attested by the Gazetted Officer or Notary Public (A) in case of Undergraduate Certificate - Copy of 10th Standard Mark Sheet - Copy of +2 Mark Sheet / Certificate
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(B) in case of Postgraduate Certificate - Copy of 10th Standard Mark Sheet - Copy of +2 Mark Sheet / Certificate - Copy of Degree Certificate / Provisional Pass Certificate - Copy of PGDIT/PGDCA Certificate b)
Xerox copy of the Marks card of all Semesters of course as mentioned at S.No.8 in the application form.
c)
Demand Draft.
(13) Fee Particulars: Fee to be paid Amount in Rs.
Category 1. Bonafide Certificate
200.00
2. Migration Certificate
200.00
3. Transcript
200.00
4. Additional copies
100.00 per copy for Transcript only
(14) In case, if the transcripts are to be dispatched directly to any University or to the student who is residing in a country other than India, the postage charges as applicable for that country as per Postal Department shall be borne by the student. The demand draft shall be made including postal charges amount as applicable. (15) Please send duly filled in application along with enclosures to the following address for Bonafide Certificate/Migration Certificate: The Additional Registrar Directorate of Distance Education Sikkim Manipal University 1st Floor, Syndicate House MANIPAL – 576 104, KANATAKA. India. (16) Please send duly filled in application along with enclosures to the following address for Transcript: The Controller of Examinations Directorate of Distance Education Sikkim Manipal University 6th Floor, Old MAHE Building Madhav Nagar, MANIPAL – 576 104, KANATAKA. India. (17) Any queries with regard to Bona fide Certificate / Migration Certificate / Transcript status email to
[email protected]. **** Page 3 of 3
